Appointments and Cancellations

Appointments are scheduled in advance, at a cadence we agree on, based on your goals, treatment needs, and our mutual availability. Payments for each appointment will be made through Headway by debit or credit card or ACH transfer.

You may cancel appointments in advance without charge, as long as I receive notice at least 24 hours in advance. For appointment no-shows or last-minute cancellations, you may be charged a $120 fee.

Availability and After-Hours Emergencies

Providers check for voice mail messages during normal business hours. Messages left outside of normal hours of operation will be picked up the next business day. If you are experiencing suicidal or homicidal thoughts, are in crisis, or need immediate help, please call 911 or go to the nearest emergency department. You can also reach out to the National Suicide Prevention Lifeline at 988 or the Trevor Project Lifeline at 1-866-488-7386.

Contacting Me

I am often not immediately available by telephone. I do not answer my phone when I am with clients or otherwise unavailable. At these times, you may leave a message on my confidential voicemail and I will return your call once I’ve reviewed your chart, but it may take a day or two for non-urgent matters. You can also send me a secure message using your account through TherapyPortal (https://www.therapyportal.com/p/connectedcare/).

I will make every attempt to inform you in advance of planned absences, and provide you with the name and phone number of the mental health professional covering my practice. If I need to cancel an appointment at the last-minute, I will reach out as soon as possible and reschedule, or have a member of my staff connect with you.

Discharge Process

There are several reasons why we may eventually end our professional relationship. You may decide you would prefer to work with a different provider. I may reach the conclusion you would be better served working with someone else. Regardless of the case, I will first discuss with you the reasons for discharging, and if you request, provide you with a list of other qualified providers. I will also extend the discharge process length if necessary based on your treatment needs, including continuing to provide emergency support for a time-limited period after you have been notified of the end of our treatment relationship.

Please note that ongoing failure to pay for treatment, attend sessions, or communicate with me in a respectful and timely manner can also result in discharge from my practice. In these instances, to ensure you have continued access to care, I will still make every reasonable effort to get in touch with you and provide referrals to a new provider before I consider our relationship ended.

Dual Relationships "You First"

We are both humans living in the world together. Because of this shared reality, we may see each other outside of our therapeutic work here. If we were to see each other, it is our policy that you (the client/patient) initiate any contact with the provider first. We do this to protect your right to privacy, and to allow you to choose whether the setting and time is right for you to say hello. We will not be offended if you choose not to engage with us outside of our therapeutic work together when happenstance or otherwise brings us into the same space.

Another reality of living in the same shared world is that we may, at times, have dual relationships. The American Psychological Association defines a dual relationship as, "a situation in which a provider has more than one type of relationship with a client." For healthcare providers, nurses, and first responders, it is possible that you will see or even engage with me in a professional setting outside of our therapeutic work together. It is also possible that we both become involved in similar faith communities, professional organizations, clubs, etc. It is my responsibility to ensure that any dual relationships we enter into will not adversely impact my professional clinical judgement and my ability to care for you. However, any dual relationship is likely to have some impact on our therapeutic relationship, even in ways that are not immediately perceptible to me or you. Should a dual relationship exist, I invite you to share any concerns you have. I am always happy to provide referrals to other providers who do not share a dual relationship with you.

Dictation Software

In order to give you the best care and attention, your provider may be using a secure service that transcribes the conversation you have with us. All transcriptions are automatically deleted after the appointment. If you don’t want your provider to be using this service, just let your provider know and they will turn it off.

Social Media

As a policy, healthcare providers are unable to accept friend requests from clients/patients, or follow clients/patients on social media.

Students and Interns

Interacting with patients in a supervised environment is part of all medical and nursing training programs. Students are required to protect patient/client's rights to privacy, and will not share your protected health information. Should a student be present in our interaction together, you are always welcome to request that the student step out and that I see you privately. You have the right to request that students or interns do not participate in your care.

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Patient Service Agreement and Consent  

Leaf Psychiatry, LLC (“Provider”) is proud to provide you with personalized support and care. Please read and sign the following agreement; it lists our billing, scheduling and cancellation policies and procedures. If you have any questions, please ask for clarification.

A.          Scheduling Services. All services can be scheduled by using Headway's website, by phone by calling Provider at 734-210-1710 or by emailing Provider at scheduling@leafpsychiatry.com. If you schedule an appointment or communicate with Provider via email, you are consenting for Provider to respond to your email utilizing the same method, even if you have not completed the email and text consent you will receive in conjunction with this Agreement. 

B.          Cash Pay Cost of Services when not using Insurance

(i)    (CPT 90792) Provider’s rate for a 60-minute initial Psychiatric Assessment visit/therapy session is $200

(ii)   (CPT 99212, or 99213, or 99214, or 99215) Provider’s rate for a Psychiatry 15-minute follow-up Evaluation and Management session is $130

(iii) (CPT 99212, or 99213, or 99214, or 99215 with CPT 90833) Provider’s rate for a 30-minute follow-up Evaluation and Management session with psychotherapy is $150

(iv) (CPT 99212, or 99213, or 99214, or 99215 with CPT 90836) Provider’s rate for a 60-minute follow-up Evaluation and Management session with psychotherapy is $185

(v)  (CPT 90834) 45-minute psychotherapy session is $165

(vi) (CPT 90836) 60-minute psychotherapy session is $185

(vii) (CPT 90847) 50-minute Family therapy session is $185

(viii) (CPT 90846) 50-minute family therapy session without primary patient present is $185

(ix) (CPT 90839) first 60 minutes of psychotherapy for a patient in crisis is $200. Crisis is when a patient requires immediate attention outside of regularly scheduled appointments for a life-threatening, complex, or high-distress situation.

i. (CPT 90840) every 30 minutes of crisis psychotherapy after the first 60 minutes will be billed at $100, rounded up to the nearest 30 minute increment.

C.          Services. You agree to receive comprehensive mental health services including Psychiatric Assessment, Medication Management, and Psychotherapy which may involve the use of Acceptance Commitment Therapy, Internal Family Systems Therapy, Prescription Medications, Over the Counter Supplement and Medication Recommendations, Nutritional Counseling, Laboratory Testing, and other interventions your provider deems appropriate. You understand the risks, benefits and alternatives of receiving these Services and have had the opportunity to ask questions.

D.             Payment Methods. You understand and agree that payment for services shall be made using Alma’s billing platform. Provider accepts payment in the form of credit card. If you will be using insurance to cover some or all of the cost of your appointment, you should enter your insurance information into the online Alma Portal at least 4 days before your session. You should be prepared to pay any co-payments at the time of the appointment with the credit card on file. If Provider is out of network for your insurance you must be prepared to pay in full for your appointment at the time of service, with credit card.

E.           Cancellation Policy. You understand that your appointment must be canceled at least twenty-four (24) hours in advance or you will be responsible for full payment for the missed visit.

F.          Confidentiality and Compliance. Provider will take appropriate precautions to keep your health information confidential and to not disclose it without your consent. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act (HIPAA) and any other applicable federal and state laws related to protection of patient information, including but not limited to Public Health Law § 18. There are certain exceptions to when your confidential information would not be protected—for instance, if Provider believes that you will harm yourself or another person or are neglecting or abusing a child or a vulnerable adult.

G.          Waiver of Liability. By signing this Agreement, you agree to waive, release and discharge Provider from any and all liability, including, without limitation, any injuries that may occur during the provision of services under this Agreement.

Acknowledgement and Agreement

I have read and understand the information provided above, and understand and agree to the terms in this Agreement, including costs of Services, payment methods and cancellation policy. Any questions I had have been answered.